Effects of Biologically Active Metabolites of Tamoxifen on the Proliferation Kinetics of MCF-7 Human Breast Cancer Cells in Vitro

Total Page:16

File Type:pdf, Size:1020Kb

Effects of Biologically Active Metabolites of Tamoxifen on the Proliferation Kinetics of MCF-7 Human Breast Cancer Cells in Vitro [CANCER RESEARCH 43, 4618-4624, October 1983] Effects of Biologically Active Metabolites of Tamoxifen on the Proliferation Kinetics of MCF-7 Human Breast Cancer Cells in Vitro Roger R. Reddel, Leigh C. Murphy, and Robert L. Sutherland1 Ludwig Institute for Cancer Research (Sydney Branch), University of Sydney, Sydney, New South Wales 2006, Australia ABSTRACT tumor tissues of patients treated with tamoxifen is DMT, with 4OHT being present at much lower concentrations (1, 7,13, 25). The effects of two major metabolites of tamoxifen, /V-de- Prompted no doubt in part by the early misidentification of the methyltamoxifen (DMT) and 4-hydroxytamoxifen (4OHT), on major metabolite as 4OHT, there has been considerable interest MCF-7 Å“il proliferation and cell cycle kinetic parameters were in the antiestrogenic and antitumor activity of 4OHT (2, 3, 6,15, compared with those of the parent compound. All three com 16, 33). In contrast, there have been very few studies on the pounds produced dose-dependent decreases in the rate of cell biological activity of DMT (6, 33). proliferation which were accompanied by decreases in the per In the present study, we have attempted to answer the follow centage of S- and G2-M-phase cells. 4OHT was 100- to 167-fold ing questions. Do the metabolites DMT and 40HT differ from more potent than both tamoxifen and DMT in producing these tamoxifen in their actions on the proliferation and cell cycle effects, and this was correlated with their relative binding affini kinetics of human breast cancer cells? What are the relative ties (RBAs) for the cytoplasmic estrogen receptor (ER) (17/3- potencies of these 3 compounds in their actions on such cells in estradiol = 100, 4OHT = 41, tamoxifen = DMT = 2). At doses vitro? What therefore is the likely contribution of each to the <2.5 ¿IM,theseeffects were completely reversed by 170-estra- antitumor activity observed in vivo? Can the relative potencies diol, but the required 170-estradiol:antiestrogen concentration of these compounds in producing these effects be related to ratios differed, i.e., 1:10 to 1:1 for 4OHT compared with 1:1000 their RBAs for the ER or the more recently described high-affinity to 1:100 for tamoxifen and DMT. Although the concentrations of antiestrogen binding site (23, 30)? 170-estradiol required for reversal were related to affinity of the It has previously been shown in this laboratory that tamoxifen metabolite for ER, they were 5- to 20-fold lower than predicted has growth-inhibitory effects on the MCF-7 human breast cancer from the measured RBAs. When the rate of cell proliferation was cell line and that not all of these effects are reversed by simul measured over a range of concentrations of antiestrogen, in the taneous treatment with 17/3-estradiol (27, 28). These inhibitory presence or absence of 17/î-estradiol,it was highly correlated effects were shown to be accompanied by accumulation of cells (r2 = 0.96) with the percentage of S-phase cells. In addition to in the GO-G! phase of the cell cycle (27, 28), due mainly to an these 17/3-estradiol-reversible events, all three compounds increase in the proportion of "slowly cycling" cells (28, 32). The caused 17j8-estradiol-irreversible cytotoxicity at higher concen MCF-7 cell line forms a particularly suitable experimental model trations (>7.5 U.MDMT and 4OHT, 10 MMtamoxifen). The order to compare the effects of tamoxifen and its metabolites since it of potency in producing this effect was DMT > 4OHT > tamox has previously been shown that metabolism of tamoxifen is ifen, which correlated with neither the RBAs for ER nor the RBAs negligible in these cells in vitro (3,14). for the high-affinity microsomal antiestrogen binding site. These data support the concept that estrogens and antiestro- MATERIALS AND METHODS gens compete for a common event which regulates the rate of cell proliferation probably by controlling the proportion of cells Cells. MCF-7 cells (26) in their 299th passage were supplied by Dr. entering S phase. Although it appears likely that ER is intimately Charles M. McGrath, Meyer L. Prentis Cancer Center, Detroit, Mich., involved in this regulatory process, 17ß-estradiol-irreversible and maintained as described previously (28). Stock cells were passaged weekly with an inoculation density of 3 x 106 cells/150-sq cm flask into mechanisms are also involved in antiestrogen action in vitro. 50 ml Roswell Park Memorial Institute Medium 1640 supplemented with 20 mw 4-(2-hydroxyethyl)-1-piperazineethanesulfonicacid buffer, 14 mM INTRODUCTION sodium bicarbonate, 5 mw L-glutamine, gentamicin (20 ¿tg/ml),insulin (10 Mg/ml), and 10% fetal calf serum. Tamoxifen, a nonsteroidal antiestrogenic compound, has been Drug Treatment. Tamoxifen [frans-1-(4-/3-dimethylaminoethoxy- widely used in the treatment of human breast cancer on account phenylM ,2-diphenylbut-1-ene], N-demethyltamoxifen [frans-1-(4-,8-meth- of its efficacy and relatively low toxicity (22). Although this agent ylaminoethoxyphenyl)-1,2-diphenylbut-1-ene], and 4-hydroxytamoxifen has been in clinical use for over a decade, the mechanism of its [frans-1-(4-0-dimethylaminoethoxyphenyl)-1-(4-hydroxyphenyl)-2-phen- action remains incompletely understood (29). ylbut-1-ene] were supplied by I. C. I., Ltd., Pharmaceuticals Division, The original studies of tamoxifen metabolism identified 4OHT2 Macclesfield, Cheshire, United Kingdom. Stock solutions (10 mw) were prepared in analytical grade ethanol and stored at -20°. These drugs as the major metabolite (11, 12), but more recently it has been shown that the major metabolite accumulating in the plasma and were added to culture medium as described previously for tamoxifen (28). 17/3-Estradiol was acquired and handled as described previously (28). 1To whom requests for reprints should be addressed. Growth Curves. Exponentially growing cells (5 x 104) from Day 5 2 The abbreviations used are: 40HT, 4-hydroxytamoxifen; DMT, N-demethylta- moxifen; RBA, relative binding affinity; ER, estrogen receptor. stock cultures (28) were inoculated into 25-sq cm flasks (Coming, N. Y.) Received April 15, 1983; accepted July 13, 1983. in 5 ml medium containing 5% fetal calf serum. When cell numbers 4618 CANCER RESEARCH VOL. 43 Downloaded from cancerres.aacrjournals.org on October 2, 2021. © 1983 American Association for Cancer Research. Tamoxifen Metabolites in MCF-7 Cells X1Ö5- 5X106- K>6- 5XW5- 1 10=- 3" 5X104- 10 8 104- 103- 103- 30 96 144 96 144 HOURS HOURS 5X10 10' 30 100 500 2500 5.000 10000 HOURS CONCENTRATION - nM Chart 1. Effect of tamoxifen (A),DMT (B), and 40HT (C)on the growth of MCF-7 cells. After 30 hr of exponential growth, cells were treated with tamoxifen, DMT, or 4OHT at concentrations of 0 (•).0.01(O), 0.1 (A), 0.5 (A), 2.5 (•),5(D), 7.5 (»),or10 ^M (O). Treated medium was changed daily thereafter, and cells were harvested and counted at 96 and 144 hr. D, cell counts at 144 hr for tamoxifen (•),DMT(A), and 4OHT (O).Points, mean of triplicate flasks from 2 experiments; bars, S.E. (n - 6). Inset, 2 to 10 nM4OHT compared with 1 pMtamoxifen at 120 hr; columns, mean of quadruplicate flasks; oars, S.E. reached approximately 1 x 10'yflask, the medium was replaced with supplied by I. C. I., Ltd., Pharmaceuticals Division, and frans-4-|3H|- fresh medium containing antiestrogen with or without 17/3-estradiol. The hydroxytamoxifen was prepared from this material by a modification of experimental medium was changed daily thereafter. Cells were harvested the high-performance liquid chromatography method of Foster ef al. (10) with 0.05% trypsin:0.02% EDTA (Flow Laboratories, Ryde, New South as follows. Isotope was applied to a Browntee RP-18 reverse-phase 10- Wales, Australia), and viable cells were counted under phase-contrast fim (22- x 0.7-cm) column and eluted in 75% methanol:25% water:0.1% on a hemocytometer or in a Model ZBI Coulter Counter (Coulter Elec diethylamine at 2.0 ml/min using a Waters Associates M45 solvent tronics, Hertfordshire, United Kingdom) after 2 and/or 4 doubling times delivery system. Column eluent was monitored by absorbance at 254 of the control population. nm and by radioactivity. The retention time of the c/s isomer was 24% Flow Cytometry. Harvested cells were stained for DMA flow cytometry longer than the frans isomer. The radioactive peak corresponding to as previously described (31) and analyzed on an ICP22 pulse cytometer /rans-4-hydroxytamoxifen was collected, dried under nitrogen, and redis- (Ortho Instruments, Westwood, Mass.). Estimates of the proportions of solved in ethanol. Aqueous solutions of fra/is-4-[3H]hydroxytamoxifen cells in Go-Gi, S, and G?-M phases of the cell cycle were computed from were prepared by drying a portion of the ethanolic solution under nitrogen the resulting DMA histograms (21). and redissolving in 10 mM Tris: 1.5 HIM EDTA buffer, pH 7.4 (TrisrEDTA Isotopes. [3H]Estradiol (100 Ci/mmol) was purchased from Amersham buffer) containing 0.2% bovine serum albumin. These solutions were International, Amersham, Buckinghamshire, United Kingdom, and [3H]- used within 24 hr of preparation. tamoxifen (71 Ci/mmol) from New England Nuclear, Boston, Mass. [3HJ- Determination of Binding Parameters. The cells used for binding 4OHT (42 Ci/mmol), a 1:1 mixture of the c/s and frans isomers, was studies were obtained by plating 2 x 106 logarithmically growing cells OCTOBER 1983 4619 Downloaded from cancerres.aacrjournals.org on October 2, 2021. © 1983 American Association for Cancer Research. R. R. Reddel et al. into 150-sq cm flasks in 50 ml medium and harvesting 6 to 7 days later nm ir §+ 1/1000 E2 m + 1/10E2 when cell numbers were 3 to 4 x 107 cells/flask.
Recommended publications
  • Prospective Study on Gynaecological Effects of Two Antioestrogens Tamoxifen and Toremifene in Postmenopausal Women
    British Journal of Cancer (2001) 84(7), 897–902 © 2001 Cancer Research Campaign doi: 10.1054/ bjoc.2001.1703, available online at http://www.idealibrary.com on http://www.bjcancer.com Prospective study on gynaecological effects of two antioestrogens tamoxifen and toremifene in postmenopausal women MB Marttunen1, B Cacciatore1, P Hietanen2, S Pyrhönen2, A Tiitinen1, T Wahlström3 and O Ylikorkala1 1Departments of Obstetrics and Gynecology, Helsinki University Central Hospital, P.O. Box 140, FIN-00029 HYKS, Finland; 2Department of Oncology, Helsinki University Central Hospital, P.O. Box 180, FIN-00029 HYKS, Finland; 3Department of Pathology, Helsinki University Central Hospital, P.O. Box 140, FIN-00029 HYKS, Finland Summary To assess and compare the gynaecological consequences of the use of 2 antioestrogens we examined 167 postmenopausal breast cancer patients before and during the use of either tamoxifen (20 mg/day, n = 84) or toremifene (40 mg/day, n = 83) as an adjuvant treatment of stage II–III breast cancer. Detailed interview concerning menopausal symptoms, pelvic examination including transvaginal sonography (TVS) and collection of endometrial sample were performed at baseline and at 6, 12, 24 and 36 months of treatment. In a subgroup of 30 women (15 using tamoxifen and 15 toremifene) pulsatility index (PI) in an uterine artery was measured before and at 6 and 12 months of treatment. The mean (±SD) follow-up time was 2.3 ± 0.8 years. 35% of the patients complained of vasomotor symptoms before the start of the trial. This rate increased to 60.0% during the first year of the trial, being similar among patients using tamoxifen (57.1%) and toremifene (62.7%).
    [Show full text]
  • Tamoxifen, Raloxifene Upheld for Prevention
    38 WOMEN’S HEALTH MAY 1, 2010 • FAMILY PRACTICE NEWS Tamoxifen, Raloxifene Upheld for Prevention BY KERRI WACHTER 9,736 on tamoxifen and 9,754 on ralox- 1.24, which was significant (P = .01). Both events) did not appear to be as effective ifene. The differences in numbers are due drugs reduced the risk of invasive breast as tamoxifen (57 events) in preventing WASHINGTON — Tamoxifen and to a combination of loss during follow- cancer by roughly 50% in the original re- noninvasive breast cancer (P = .052). raloxifene offer women at high risk of up or follow-up data becoming available port (median follow-up 47 months). “Now with additional follow-up, those developing breast cancer two effective for women who were lost to follow-up “We have estimated, however, that differences have narrowed,” he said. At options to prevent the disease, based on in the original report. Women on ta- this difference in the raloxifene-treated 8 years, there was no statistical signifi- 8 years of follow-up data for more than moxifen received 20 mg/day and those group represents 76% of tamoxifen’s cance between the two groups with a 19,000 women in the STAR trial. on raloxifene received 60 mg/day. chemopreventative benefit, which trans- risk ratio of 1.22 (P = .12). The relative While tamoxifen proved significantly At an average follow-up of 8 years, the lates into at 38% reduction in invasive risk of 1.22 favors tamoxifen, but ralox- more effective in preventing invasive breast relative risk of invasive breast cancer on breast cancers,” Dr.
    [Show full text]
  • Chemotherapy Regimen: Tamoxifen
    Tamoxifen Chemotherapy Teaching The Center for Breast Cancer Mass General Cancer Center Center for Breast Cancer Topics to Discuss: • How Tamoxifen works • How Tamoxifen is taken • Storage, Handling, and Disposal • Drug Interactions • Side Effects & How to Manage • Supportive Care Resources • Your Breast Cancer Team • When to Call • Important Phone Numbers 2 What is TAMOXIFEN? • TAMOXIFEN (Nolvadex®) is an oral hormonal therapy used for hormone-sensitive breast cancers. • It works by blocking estrogen from binding to hormone receptors. This: • decreases the chance of breast cancer returning (recurrence) • decreases tumor size • delays tumors from spreading (progression) • Your care team will talk with you about how long you will need to take this therapy. – It is common to be on therapy for 5-10 years. 3 How is it taken? • TAMOXIFEN is a tablet you take by mouth. • Take one tablet (20 mg) once daily with or without food at the same time each day. – Do not take with grapefruit juice. • Swallow tablet whole with water. Do not break, chew, or crush your tablet. • If you miss a dose, skip the dose. Do not take 2 doses at the same time to make up for the missed dose. 4 Storing and Handling • Keep TAMOXIFEN in its original bottle or in a separate pill box – do not mix other medicines into the same pill box. • Store at room temperature in a dry location away from direct light. • Keep out of reach from children and pets. • Wash your hands before and after handling. – If someone else will be handling your TAMOXIFEN, have them wear gloves so they do not come into direct contact with the medicine.
    [Show full text]
  • Effect of Tamoxifen Or Anastrozole on Steroid Sulfatase Activity and Serum Androgen Concentrations in Postmenopausal Women with Breast Cancer
    ANTICANCER RESEARCH 31: 1367-1372 (2011) Effect of Tamoxifen or Anastrozole on Steroid Sulfatase Activity and Serum Androgen Concentrations in Postmenopausal Women with Breast Cancer S.J. STANWAY1, C. PALMIERI2, F.Z. STANCZYK3, E.J. FOLKERD4, M. DOWSETT4, R. WARD2, R.C. COOMBES2, M.J. REED1† and A. PUROHIT1 1Oncology Drug Discovery Group, Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London W12 0NN, U.K.; 2Cancer Research UK Laboratories, Department of Oncology, Hammersmith Hospital, London W12 0NN, U.K.; 3Reproductive Endocrine Research Laboratory, University of Southern California, Keck School of Medicine, Women’s and Children’s Hospital, Los Angeles, CA, U.S.A.; 4Department of Biochemistry, Royal Marsden Hospital, London, SW3 6JJ, U.K. Abstract. Background: In postmenopausal women sulfate and dehydroepiandrosterone levels. Results: Neither estrogens can be formed by the aromatase pathway, which anastrozole nor tamoxifen had any significant effect on STS gives rise to estrone, and the steroid sulfatase (STS) route activity as measured in PBLs. Anastrozole did not affect which can result in the formation of estrogens and serum androstenediol concentrations. Conclusion: androstenediol, a steroid with potent estrogenic properties. Anastrozole and tamoxifen did not inhibit STS activity and Aromatase inhibitors, such as anastrozole, are now in serum androstenediol concentrations were not reduced by clinical use whereas STS inhibitors, such as STX64, are still aromatase inhibition. As androstenediol has estrogenic undergoing clinical evaluation. STX64 was recently shown properties, it is possible that the combination of an to block STS activity and reduce serum androstenediol aromatase inhibitor and STS inhibitor may give a therapeutic concentrations in postmenopausal women with breast cancer.
    [Show full text]
  • Comparison Between Two Methods of Ovulation Induction: Clomiphene Alone and Clomiphene +Tamoxifen in PCOS Patients
    Iranian Journal of Reproductive Medicine Vol. 2. No.2 pp:74-77, 2004 Comparison between Two Methods of Ovulation Induction: Clomiphene alone and Clomiphene +Tamoxifen in PCOS Patients Mohammad Ghafourzadeh, M.D.1, Mojgan Karimi M.D.2, Mohammad Ali Karimazadeh, M.D. 3, and Mahshid Bokai,B.S. 4 1,2,3,4 Shahid Sadoughi Univerisity of Medical Sciences and Health Services of Yazd, Iran. Background: Infertility affects about 10-15% of reproductive-age couples. About half the causes of infertility are female related and approximately 40% of the cases are caused by anovulation, mostly in PCO women. Objective: This study was conducted to determine and compare the effects of two drug treatment regimens: higher dose of clomiphene and a combination of lower dose of clomiphene and tamoxifen in treating infertile women with PCO. Materials and Methods: The study was a randomized clinical trial conducted on 100 infertile patients who referred to Yazd-Iran Infertility Clinic between the years 2001-2003. The patients were selected who had received at least 3 periods of clomiphene, but no pregnancy had occurred. They were randomly divided into two groups. In the first group, clomiphene was increased to 100 mg and the second group 20 mg of tamoxifen was added to 50 mg of clomiphene from day 5-9 of menstruation cycle. Infertility duration, duration of medicine used, PCT score, endometrial thickness, ovulation, and pregnancy rate were studied in both groups. Results: Ovulation rate in clomiphene group was 54.9%; Tamoxifen + clomiphene group was 73.5% without significant differences in both groups. (PV = 0.053).
    [Show full text]
  • Integrating Personalization of Treatment with Tamoxifen Into
    ical C eut are ac & m H r e a a h l t P h f S o y Journal of l s a t n e r m Ibrahim, J Pharma Care Health Sys 2016, 3:2 u s o J DOI: 10.4172/2376-0419.1000162 ISSN: 2376-0419 Pharmaceutical Care & Health Systems Research Article Open Access Integrating Personalization of Treatment with Tamoxifen into Pharmacy Practice Via Clinical Pharmacist Role in Therapy Management Nagwa Ibrahim* Department of Pharmaceutical Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia *Corresponding author: Nagwa Ibrahim, Department of Pharmaceutical Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia, Tel: 00966-4777714; E- mail: [email protected] Received date: Jun 14, 2016; Accepted date: Jun 20, 2016; Published date: Jun 24, 2016 Copyright: © 2016 Ibrahim N. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The concept of individualized therapy is intended to deliver the right therapy to the right patient at the right time. Personalization of treatment aims to shift health care from population based or empirical approach to scientifically tailored approach. Pharmacogenenetics use the genetic information such as DNA sequence, gene expression and copy number to explain the inter-individual differences in drug metabolism (pharmacokinetics) and physiological drug response (pharmacodynamics), to predict the efficacy and toxicity of drugs and to identify responders and non responders to a specific drug. Success of the personalized medicine depends on the identification of predictive biomarkers and development of accurate and reliable diagnostics.
    [Show full text]
  • Tamoxifen Or Any Other SOLTAMOX Ingredient SOLTAMOX® Safely and Effectively
    HIGHLIGHTS OF PRESCRIBING INFORMATION -------------------------------CONTRAINDICATIONS------------------------------ These highlights do not include all the information needed to use • Known hypersensitivity to tamoxifen or any other SOLTAMOX ingredient SOLTAMOX® safely and effectively. See full prescribing information for (4) SOLTAMOX®. • In patients who require concomitant warfarin therapy or have a history of deep vein thrombosis or pulmonary embolus, if the indication for treatment ® SOLTAMOX (tamoxifen citrate) oral solution is either reduction of breast cancer incidence in high-risk patients or risk Initial U.S. Approval: 1977 reduction of invasive breast cancer after treatment of DCIS (4) WARNING: UTERINE MALIGNANCIES and -----------------------WARNINGS AND PRECAUTIONS------------------------ THROMBOEMBOLIC EVENTS • Uterine malignancies: Promptly evaluate abnormal vaginal bleeding in a See full prescribing information for complete boxed warning. woman with current or past tamoxifen use. (5.1) • Serious, life-threatening, and fatal events from use of tamoxifen • Thromboembolic events: Risk increases with coadministered include uterine malignancies, stroke, and pulmonary embolism. (5.1, chemotherapy. For treatment of breast cancer, consider risks and benefits 5.2) in patients with a history of thromboembolic events. (5.2) • Discuss risks and benefits of tamoxifen with women at high risk for • Embryo-fetal toxicity: Can cause fetal harm. Advise females of breast cancer and women with ductal carcinoma in situ (DCIS) when reproductive potential of the potential risk to a fetus and to use effective considering tamoxifen use to reduce the risk of developing breast contraception. (5.3, 8.1, 8.3) cancer. (5.1, 5.2) • Effects on the liver: Liver cancer and liver abnormalities, some fatal, • For most patients already diagnosed with breast cancer, the benefits of have occurred.
    [Show full text]
  • Generating a Precision Endoxifen Prediction Algorithm to Advance Personalized Tamoxifen Treatment in Patients with Breast Cancer
    Journal of Personalized Medicine Review Generating a Precision Endoxifen Prediction Algorithm to Advance Personalized Tamoxifen Treatment in Patients with Breast Cancer Thomas Helland 1,2,3,* , Sarah Alsomairy 1, Chenchia Lin 1, Håvard Søiland 3, Gunnar Mellgren 2,3 and Daniel Louis Hertz 1 1 Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA; [email protected] (S.A.); [email protected] (C.L.); [email protected] (D.L.H.) 2 Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway; [email protected] 3 Department of Clinical Science, University of Bergen, 5007 Bergen, Norway; [email protected] * Correspondence: [email protected]; Tel.: +47-92847793 Abstract: Tamoxifen is an endocrine treatment for hormone receptor positive breast cancer. The effectiveness of tamoxifen may be compromised in patients with metabolic resistance, who have insufficient metabolic generation of the active metabolites endoxifen and 4-hydroxy-tamoxifen. This has been challenging to validate due to the lack of measured metabolite concentrations in tamoxifen clinical trials. CYP2D6 activity is the primary determinant of endoxifen concentration. Inconclusive results from studies investigating whether CYP2D6 genotype is associated with tamoxifen efficacy may be due to the imprecision in using CYP2D6 genotype as a surrogate of endoxifen concentration Citation: Helland, T.; Alsomairy, S.; without incorporating the influence of other genetic and clinical variables. This review summarizes Lin, C.; Søiland, H.; Mellgren, G.; the evidence that active metabolite concentrations determine tamoxifen efficacy. We then introduce a Hertz, D.L. Generating a Precision novel approach to validate this relationship by generating a precision endoxifen prediction algorithm Endoxifen Prediction Algorithm to and comprehensively review the factors that must be incorporated into the algorithm, including Advance Personalized Tamoxifen genetics of CYP2D6 and other pharmacogenes.
    [Show full text]
  • A Randomized Phase II Study of Letrozole Versus Observation in Patients with Newly Diagnosed Uterine Leiomyosarcoma 2006-0453
    2006-0453 Revised 4/29/2009 Page 1 Protocol Page A Randomized Phase II Study of Letrozole Versus Observation in Patients with Newly Diagnosed Uterine Leiomyosarcoma 2006-0453 Core Protocol Information Short Title Letrozole versus observation in patients with newly diagnosed uterine leiomyosarcoma Study Chair: Robert Coleman Additional Contact: Aileen Maloney Jacalyn B. Gano PDOL OPR DMC Addl Cont Department: Gynecologic Oncology Phone: 713-794-1422 Unit: 1352 Full Title: A Randomized Phase II Study of Letrozole Versus Observation in Patients with Newly Diagnosed Uterine Leiomyosarcoma Protocol Type: Standard Protocol Protocol Phase: Phase II Version Status: Terminated 07/24/2017 Version: 08 Submitted by: Aileen Maloney--6/8/2009 10:18:41 AM OPR Action: Accepted by: Leola M. Jones -- 6/16/2009 1:06:28 PM Which Committee will review this protocol? The Clinical Research Committee - (CRC) 2006-0453 Revised 4/29/2009 Page 2 Protocol Body 1.0 Objectives To prolong the time to recurrence for patients with clinical stage I and II uterine LMS assigned to letrozole therapy. The primary endpoint of this study will be a prolongation of time to disease recurrence. 2.0 Background Letrozole (4,4'-(1H-1,2,4-Triazol-1-ylmethylene)bis-benzonitrile) is a synthetic achiral benzydryltriazole derivative. It is an orally active highly selective non-steroidal competitive inhibitor of the aromatase enzyme system [1,2]. Aromatase inhibitors block the aromatase enzyme, consequently lowering estrogen levels and thereby deprive the tumor of its growth stimulus. Letrozole effectively inhibits the conversion of androgens to estrogens in both in vitro and in vivo [1].
    [Show full text]
  • Editorial.Final 10/20/06 1:39 PM Page 10
    OBG_11.06_Editorial.final 10/20/06 1:39 PM Page 10 EDITORIAL Is Premarin actually a SERM? It acts like a SERM... onjugated equine estrogen Effects of tamoxifen and Premarin (Premarin) has historically been Initially, tamoxifen was characterized as an C characterized as an estrogen ago- “anti-estrogen,” but it is now recognized nist. But the report from the Women’s that tamoxifen has mixed properties. It is an Health Initiative that long-term Premarin estrogen antagonist in some tissues (breast) Robert L. Barbieri, MD Editor-in-Chief treatment is associated with a reduced risk and an estrogen agonist in other tissues of breast cancer raises the possibility that (bone). To recognize these mixed estrogen Premarin may have both estrogen agonist agonist–antagonist properties, tamoxifen is and antagonist properties. Premarin may now categorized as a SERM. Premarin and actually be better categorized as a selective tamoxifen share many similarities in their estrogen receptor modulator (SERM). effects on major clinical outcomes in post- ® Dowden Healthmenopausal Media women (Table, page 13), WHI: Premarin vs placebo including their effects on breast and In the Premarin vs placebo arm, approximately endometrial cancer, deep venous thrombo- 10,800Copyright postmenopausalFor personal women with ause prior onlysis, and osteoporotic fracture. One clinical- hysterectomy who were 50 to 79 years of age ly important divergence is that tamoxifen were randomized to Premarin 0.625 mg daily or increases and Premarin decreases vasomo- an identical-appearing placebo.1 After a mean tor symptoms. FAST TRACK follow-up of 7.1 years, the risk of invasive breast Commonly used medications that inter- In any case, cancer in the women treated with Premarin was act with the estrogen receptor can be 0.80 (95% confidence interval [CI], 0.62–1.04, arranged along a continuum from a “pure” “Use the lowest P=.09).
    [Show full text]
  • Exploiting Our Contemporary Understanding of the Molecular Pharmacology of the Estrogen Receptor to Develop Novel Therapeutics By
    Exploiting Our Contemporary Understanding of the Molecular Pharmacology of the Estrogen Receptor to Develop Novel Therapeutics by Kaitlyn Jo Andreano Department of Pharmacology and Cancer Biology Duke University Date:_______________________ Approved: ___________________________ Donald McDonnell, Supervisor ___________________________ Kris Wood, Chair ___________________________ Cynthia Kuhn ___________________________ James Alvarez ___________________________ Jeffrey Marks Dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Pharmacology and Cancer Biology in the Graduate School of Duke University 2020 ABSTRACT Exploiting Our Contemporary Understanding of the Molecular Pharmacology of the Estrogen Receptor to Develop Novel Therapeutics by Kaitlyn Jo Andreano Department of Pharmacology and Cancer Biology Duke University Date:_______________________ Approved: ___________________________ Donald McDonnell, Supervisor ___________________________ Kris Wood, Chair ___________________________ Cynthia Kuhn ___________________________ James Alvarez ___________________________ Jeffrey Marks An abstract of a dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Pharmacology and Cancer Biology in the Graduate School of Duke University 2020 Copyright by Kaitlyn Jo Andreano 2020 Abstract The estrogen receptor (ER/ESR1) is expressed in the majority of breast and gynecological cancers. As such, drugs that inhibit
    [Show full text]
  • Confidential Information Which Is the Property of ITF
    ITFE-2026-C10 (BLISSAFE) EudraCT number: 2014-004517-84 Protocol ITFE-2026-C10 A PHASE II PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED AND MULTI-CENTRE CLINICAL TRIAL TO ASSESS THE SAFETY OF 0.005 % ESTRIOL VAGINAL GEL IN HORMONE RECEPTOR-POSITIVE POSTMENOPAUSAL WOMEN WITH EARLY STAGE BREAST CANCER IN TREATMENT WITH AROMATASE INHIBITOR IN THE ADJUVANT SETTING. “BLISSAFE Study” Sponsor: ITF RESEARCH PHARMA S.L.U Polígono Industrial de Alcobendas C/San Rafael, 3 28108 Alcobendas (Madrid), Spain Phone: +34 91 6572323 Fax: +34 91 6572366 Email: [email protected] Protocol-specific Sponsor contact information can be found in the Administrative Binder. STUDY CHIEF INVESTIGATOR: Dr. Pedro Sánchez Rovira, Complejo Hospitalario de Jaén Sponsor Study Code: ITFE-2026-C10 EudraCT Number: 2014-004517-84 Protocol Approved by ITF RESEARCH PHARMA (ITF): 26-November-2014 CONFIDENTIAL The information and data included in this protocol contain secrets and privileged or confidential information which is the property of ITF. No one is authorized to make this information public without the written permission of ITF. These limitations shall also be applied to all the information considered to be privileged or confidential and provided in the future. This material can be disclosed and used by its equipment and collaborators as necessary for conducting the clinical trial. Protocol version 1.0: 26-November-2014 Página 1 de 61 ITFE-2026-C10 (BLISSAFE) EudraCT number: 2014-004517-84 SUMMARY OF THE STUDY PROTOCOL Study Title: A PHASE II PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO- CONTROLLED AND MULTI-CENTRE CLINICAL TRIAL TO ASSESS THE SAFETY OF 0.005% ESTRIOL VAGINAL GEL IN HORMONE RECEPTOR-POSITIVE POSTMENOPAUSAL WOMEN WITH EARLY STAGE BREAST CANCER IN TREATMENT WITH AROMATASE INHIBITOR IN THE ADJUVANT SETTING.
    [Show full text]